Expert Insights: Interview with Dr. Vish Viswanath May 5, 2021

Regulation | May 05, 2021 | by Jill Schumann

Vish Viswanath, PhD, Professor of Health Communication at the Harvard Chan School of Public Health and the Dana-Faber Cancer Institute, joined the LeadingAge Coronavirus Update Call on May 5, 2021.

Vish Viswanath, PhD, Professor of Health Communication at the Harvard Chan School of Public Health and the Dana-Faber Cancer Institute, joined the LeadingAge Coronavirus Update Call on May 5, 2021. He responded to questions from Ruth Katz and from callers.

Q: Our members have seen that most older adults have readily agreed to be vaccinated. Their staff members have been slower to be vaccinated and it appears that some are adamant about not being vaccinated. Can they be convinced?

A: From studies and surveys it looks like 25-35% of people have said they are unlikely to be vaccinated. We need to take a closer look at this group as it is not homogeneous. We need to figure out who is open to conversation and customize our communications to them based on their specific concerns. This issue of COVID vaccines is so important that I don’t give up easily, but I also recommend strategic investments of time and resources.

Q: How might you determine who are, as you say, “fence sitters” versus “refusers”?

A: Generally, a hesitant person might say that they want to wait and see or offer some specific fear or reason for not wanting the vaccine. Often, if we get the right information to them from the right messengers, we can address their concerns. However, the messengers must believe in the vaccine. We know from HPV vaccinations that if the physician is personally hesitant about the vaccine, parents will pick up on that and not want to get their child vaccinated. But refusers will simply say they are not going to get it – period.

Q: What should we do about that last group who are refusers?

A: We are not sure what the actual number is. Likely the refusers are only 10-15%. For example, we know that only about 10% of people refuse to have their children vaccinated. For people who are completely refusing it usually does not have anything to do with the science of COVID- 19. There is not much you can do in the conversation because people may just become more resistant and assume you are part of the COVID conspiracy.

For the refusers, there are basically two options. The first is the institutional option – to say, if you are working in our organization and are helping high risk people, you are mandated to get the vaccine. The other option is to engage individually with people who are refusing and to talk about the need to protect the needs of the vulnerable people you serve.

Q: What are your thoughts about mandating vaccines?

A: Each institution will have to make its own decision about that. But if you are taking care of a high -risk group it may be necessary.

Q: Is there a reason to think fence sitters and refusers will be motivated by a focus on the older adults in their care?

A: Yes, fence sitters may be receptive if they understand themselves to be at risk or taking care of people who are at risk. However, for refusers that may be less successful.

Q: What are your thoughts about the pause with the Johnson and Johnson vaccine?

A: It did worry me that it would increase hesitancy. I have emphasized two points: these cases are rare and also that the vaccine was paused to look closely at the data before moving forward. That tells us the system is working.

Q: Is there anything we can learn from this COVID-19 vaccine experience that will help us with uptake for the seasonal flu vaccine?

A: Flu vaccine uptakes generally are low, especially among younger people. We can use the same health communication principles and think of the compliant, fence sitters and refusers in much the same way. For those who are hesitant we need to listen, understand, engage, and provide information and perspectives. As we focus on physicians and other health workers as messengers, we need to equip them with messaging scripts.

Q: How might we respond to people who argue that the fact that they have had COVID-19 means they have antibodies and don’t need to be vaccinated?

A: Some people say that because they genuinely believe they are protected, and we need to let them know that we don’t know how long immunity will last, nor what effect variants might have. For those who are using that as excuse – well that’s a very different conversation and we need to get to the underlying concerns.